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So you’ve landed the long awaited internship opportunity. No more showing up at potential sites with yet another fine linen resume, ink barely dry, hoping that the clinician you seek isn’t behind with their case notes for that particular day nor finds your beard particularly disturbing. You discovered that diamond in the rough, a chance to begin the final chapter of likely your largest financial investment to date. What now?

Here are a few points to guide you toward the successful completion of your clinical internship, the culminating experience of your mental health degree.

Establishing a plan. While you will be told this, probably understand its necessity and are likely doing so as a requirement, you should really take the time to thoughtfully plan. Ideally your plan for your clinical experience is done through conversation with your supervisor. Items such as schedule availability for client contact as well as individual and group supervision is a must, but also include how supervision will transpire (e.g. video recording, in-person, verbatim, etc.). One plausible sticking point may be satisfying the CACREP criteria for “some” experience in leading groups. Discuss this note specifically with your supervisor.

Do the math. How many hours do you need per week to complete your program in your desired (or required) timeline? Don’t forget to plan for academic breaks, vacations and other schedule conflicts.

Consider the caseload of the site. Ask your supervisor if it is feasible to maintain a steady caseload throughout the year. Many practices see a decrease in clientele during particular times of year. Don’t believe the minimum is enough, plan for being sick, fluctuating caseloads, no shows and cancellations. Contemplate the impact of time requirements for endeavors such as school or home visits and coordinating care.

And remember, while you can likely continue to accumulate hours during breaks within the semester, you will most likely not be able to accumulate hours between semesters. These weeks add up. In the end, it’s more advantageous to have too many hours than not enough. The more hours the more experience you have moving forward. Not enough hours likely results in another academic semester!

Setting goals. Goals related to competence not simply having the goal of completing the requisite hours. Having goals related directly to completing your degree and to becoming a better counselor are necessary to get the most out of this phase of your journey. For example, if you plan to get licensed, you will have to pass a state exam. Have a resource such as the Encyclopedia of Counseling handy. Have access to resources related to your theory of choice and research interventions which may relate to your current caseload.

At this stage, you may benefit from reviewing case notes or assessments and relating themes, symptoms, and processes with the material you have learned and are learning in school. Put your goals on paper, ask for feedback and if your school doesn’t provide a form, find a way to track your progress. Through discussion, compare your self-evaluation with your supervisor’s observations.

Calculating hours. Understand how your hours should be counted. This should meet your academic requirements and also the educational requirements for the state you wish to eventually seek licensure. This includes distinguishing what, if any, of your academic class time counts as supervision. Additionally, understand that your administrative proficiency will likely increase over the course of your clinical training experience. Items such as post-session notes and case management will take up a great deal of your time early on, this may mean less time for client-contact. However, be abreast of lulls that may occur as your administrative proficiency increases and work with your supervisor to adjust your caseload accordingly.

Understand co-therapy is not merely sitting in observing your supervisor conduct a session. Get clarity from both your state board and your academic institution regarding distinguishing time being observed, doing observation and engaging in co-therapy. Calculating your hours is dependent upon your role in the session, not necessarily how you refer to the experience. I’m sure you know the importance of keeping record of your time, but I’d be remiss not to mention it. Minding confidentiality, make your records inclusive. This is not only a requirement, if done particularly can provide you with valuable qualitative and quantitative information for job seeking purposes later on.

Remembering the hierarchy. Yes, you’re thinking about Maslow which is great, but here I am reminding you the client always comes first. Early on you may find yourself sitting in during sessions. Clients’ permission must be obtained prior to sitting in during a counseling session whether or not co-therapy is being performed. If a client declines to permit you into a session, don’t take it personally. There are too many possible reasons for such a decision by a client and the overwhelming majority of those possible reasons likely have little to do with you personally. The client’s needs are above both site and school requirements.

This can be a complex concept or a non-issue, but should remain central to the therapeutic process. A common reason clients prefer not to introduce you into the session, especially early in the internship, is because they have established rapport with their counselor and are simply comfortable working with that person in the established manner. As new clients arrive at the site, it becomes easier to integrate you into the process.

Minding your own mental health. Don’t forget your own mental health. Counselors in training may be on the extremes concerning time. Some interns may not have much else going on other than their internship while others are working several jobs and have others who are dependent on them. In either case, beware of countertransference. If your emotions are high and/or out of control you may run a risk of losing track of the therapeutic process. While in itself countertransference is not necessarily a fault, ignorance of its presence can be harmful to the client as well as result in ethical dilemma. If at any time you feel concerned about your feelings toward or relating to a client a discussion with your supervisor should be in order. Establishing good routines which include eating appropriately, drinking water, sleeping, and exercising are important. Also, schedule some “me time” in between your school work, clinical work, and other obligations.

Assuring confidentiality and ethical standards. Client’s names are never presented to individuals at your academic institution; initials are acceptable. Concerning client information, a good rule of thumb is maintaining a double lock standard. This relates to traveling to and from the site, storage at home, laptops, audio/video recording devices, etc. Client paperwork and digital information should be protected and stored until the statute of limitations on malpractice expires or you graduate, whichever occurs last. In general, when there are competing guidelines always defer to the higher standard. Remember, guidelines are set by your academic institution, the internship site, state law, associations Codes of Ethics, etc. You won’t be the first to find it confusing at times.

Furthermore, understand ethics codes generally act as guidelines. They may lack clarity, conflict with laws, be reactive versus proactive, etc. Being ethically responsible as a counselor is not necessarily complicated but it takes being educated and appropriately mentored to hone in on best practice. Some points to remember include the importance of informed consent. Specifically state your status as a graduate intern, your requirement to be supervised and note how your work with them may be integrated into your scholastic endeavor. Of course, always get permission (often by way of a Release Form either from your site or academic institution) from clients prior to any type of recording of session content. For individuals under 18, it is best practice to have both the client and their legal guardian grant written permission.

You may have heard it before, but don’t forget it:

Don’t be on time, be early.

Maintain liability insurance. You may have to renew this during the course of your training.

Dress appropriately and maintain acceptable grooming standards.

Expect to be introduced as an intern. Prepare for this. It may prove more difficult to deal with than you think.

Caring confrontation. Yes, with your clients but also with your supervisor. For example, find ways to improve the environment or administrative processes and make suggestions. As well, it has likely been some time since your supervisor completed her degree. Offer discussions based on things you are learning in your academic setting. Be an asset! You’ll likely be looking for a job and/or supervision after graduation to suffice your state requirements. Your current site could offer to keep you on if you’re valuable or at the least offer you a solid reference letter.

Concentrate on what you do well, as well as things you don’t. Use this supervised experience to face what you feel is most challenging and leverage your current skill set to overcome your fears. Work with silence, work with children, work with the opposite gender, etc. Do it while you have help readily available.

“Tires will smoke when you reach the point of volatility or vaporization of the materials in the tread compound,” says Goodyear race-tire engineer Robert Bethea (as quoted in Huffman, 2011).

I know where all the statistically genius minds went but never mind the association of standard deviation and variance with volatility. This isn’t a composition on research and evaluation, so for the other 98% of you out there, keep reading. This is actually your invitation to take a vacation this summer.

Why? To avoid the smoke. After all, one thing caregivers, therapists, and race cars have in common is the potential for burnout.

There is often a distinction made between burnout and compassion fatigue. Burnout is recognized as being more predictable, as it occurs over time, and is less treatable. Marked by chronic stress, irritability, low self-esteem, and exhaustion, burnout symptomatically resembles depression and anxiety. Compassion fatigue on the other hand, can happen suddenly and is associated with a shock or stress reaction to helping or desiring to help others. However, similarly, compassion fatigue can result in chronic physical and emotional exhaustion, depersonalization, somatic complaints, irritability and difficulty sleeping. Both burnout and compassion fatigue occur in situations where the susceptible individual is caring for or desires to assist a person who has experienced trauma or is experiencing emotional distress. Therapists, lawyers, and nurses are among the individuals who should be concerned with self-monitoring for burnout.

Essentially, in a mental health setting, therapists are subject to burnout if they are affected by their clients’ stories outside of work. In order to prevent burnout, workloads must be manageable, vacations and time-off must be observed, and sleep should be monitored; journaling as well as exercise are also preventative measures. As a medical or helping professional, it is necessary to collaborate with peers, mentors, and supervisors throughout one’s career vice simply when a problem is identified. These long-standing relationships in themselves may very well be the best preventative measure against burnout. Isolated environments such as private practice increase susceptibility to the aforementioned and other ethical hazards. Simply put, notwithstanding your experience, or how well you do your job, a level of vulnerability exists. No matter where you are in your career, it is always a great time to assess the measures you have in place to protect yourself and those you serve. The less supervision you require, the further removed you become from your formal training, and the more isolated you are from peers—the greater the risk.

So before your office is filled with smoke and you completely breakdown all of your grey matter, take a moment to evaluate the conditions—your condition and those around you. Be encouraged to create and sustain an atmosphere that is conducive for your work, and concerning the signs of burnout, remain vigilant.

Criterion A.2. of Alcohol Use Disorder, as presented in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), is the foundation for my conceptualization of alcoholism as either a disease or a behavior. Obviously a person who meets the criteria for a mental disorder warrants a diagnosis of a mental disorder, right? Isn’t the DSM gospel? Okay, so cynicism aside, the criterion of which I am referring is as follows: “There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.” In short, if a person is behaving in a manner that they do not wish to behave, and they have put forth significant honest efforts to stop that behavior (or emotion, etc.) then they need help. If help is most effective by way of mental health intervention, then I believe that the mechanisms should be in place for that assistance to be received (thus a diagnosis be present within the DSM).

It is in the assessment of the criterion of reference where the distinction is made between people who are engaging in an irresponsible manner versus a person who is “ill”. I would almost go as far as to say that the criterion should be listed separately from the others and be required in addition to “at least two of the others.” The reality is that due to its subjectability, the criterion is not a foolproof method for determining “disease.” What a person says they have done to stop, cut down or control alcohol is unfortunately not always factual in nature. This in itself creates a conflict with therapeutic approaches that the clinician accepts the client’s reality (regardless of truth), similar to the process of dealing with victims of violence or abuse.

Gaining an understanding of the hopelessness a client feels is often a prerequisite for intervention (which sometimes proves therapeutic in itself); however, validation of the hopelessness should not be required of a clinician. With this thought process in mind, which is often best, clinicians commit due diligence to understanding the problem as the client sees it, and make some efforts to validate the claims the client makes with regard to their unsuccessful efforts to control their alcohol use.

During this validation process it is useful to understand the means by which the client has presented themselves to therapy. Was it court-ordered, were they pressured or did they come on their own accord? The reason for a client sitting in your office is oftentimes a predictor of the level of expected success, though asking the client directly may be illuminating as well.

With the work of Michele Weiner-Davis in mind, a therapist should also search for evidence of pretreatment change. These are all factors that are associated with determining the “classification” of alcoholism and more importantly the need for intervention. Regardless of how it’s classified, as a clinician, with a client sitting in front of you, you have an obligation.

Consideration of the factors mentioned above may also serve as a guide to a therapist evaluating which approach to intervention may best suit a particular client. Due to my affinity for Marriage and Family Therapy, I would be remiss if I didn’t mention an assessment of the effects of the alcohol use, regarding the family (if present), should also be a factor in determining the goals of therapy.

Cultural competence is, without a doubt, required of clinicians who provide therapy to culturally diverse clients. The acquisition of both knowledge and skills, but moreover, the ability to deal with powerful emotional reactivity and unconscious biases associated with race are incumbent (Sue, 2010). When counseling clients who are culturally different, the competent therapist must be aware of the possibility of being uncertain regarding therapeutic discussions of sensitive topics. In order for a clinician to be culturally competent and provide effective therapeutic assistance, one must be knowledgeable of cultural needs, to include language, religion, food, racial identity, and customs (Allain, 2007).

Throughout your professional career a continual effort should be placed on seeking total cultural competence, especially concerning the cultures that will primarily comprise your clientele. As I have not exactly nor assuredly settled into my foreseen client-base, for comparative purposes I will refer to Fairfield County, South Carolina in this composition, as this is the location of many of my relatives. The demographics of this area (as interpreted from the United States Census Bureau) possess a different skew than the United States, as well as the state of South Carolina, in that African Americans at 59% of the population are the majority race, followed by Whites at 39%. American Indian, Alaska Native, Asian and multiracial individuals comprise less than 2% collectively, while an estimated 1.5% of these individuals are of Hispanic origin.

In addition, the percentage of poverty in Fairfield County is 24%, whereas the United States average is near 15%. While Fairfield County is diverse, it is so in its own right. The dynamics of this population create cultural norms that are not necessarily reflected by the perception of American culture at large. A therapist working in this area must understand the intricacies of the cultures, to include cultural beliefs and values based on race, poverty and the availability of resources.

Taking a look at Fairfield County’s majority. When any helping professional provides counseling to an individual of African American culture, there are several factors one must keep in the forefront in order to reach successful therapeutic treatment. The primary factor is that of cultural competence, as it would be when counseling a member of any culture. However, the therapist’s cultural competence is vital to the treatment of African Americans as it is quite common for an individual from this cultural background to be misdiagnosed, and subsequently incorrectly counseled. This is often the result of the impact their culture’s history, racism, and oppression have had on their individual personality, as well as to their entire group as a national minority. Although the clinician, no matter their race, will be unable to dispel any opinions the African American individual may harbor regarding discrimination, it remains their responsibility to aid the individual in attaining cultural acceptance—within their cultural group, as well as all others—and ultimately establishing their autonomy.

Therapists should abide by an obligation to aid the client in constructing the framework leading to development of the client’s autonomy. This is especially the case when counseling individuals in the African American culture, where it is vital for them to become self-aware and fully autonomous as this quality will allow them the capability of personally conquering the effects of discriminatory encounters and the spectrum of microagressions they are guaranteed to continue facing. In order for a clinician to aid in the process of developing racial identity in persons of color, the therapist must guide them in establishing a passive acceptance of the self as inferior, and then facilitate the client to overcome internal racism and develop a self-affirming identity (Constantine, 2005).

When the minority is the majority, such as the case of African Americans in Fairfield County, the therapeutic approach and methodology to counsel these individuals cannot be based solely on their role as a United States minority group, but also their role as a regional majority. The primary adjustment to therapeutic intervention regarding this cultural group involves understanding the effects of, and relationship between, the national and regional cultures through the eyes of the individual.

The national majority. For a clinician to successfully treat members of the Caucasian American culture, they must again utilize their cultural competence when formulating the framework to develop the well-being of these individuals. In regard to the general population of the United States, Caucasians are the majority culture group. And in this light, the therapist’s objective would be to guide them in becoming more culturally aware, as well as to increase their own self-awareness. This would allow them to gain understanding in their typecast role as “oppressor,” acknowledging their unearned assets that constitute White privilege, and adjust their viewpoint with the goal of eliminating any harbored microagressions.

The therapist should assist them in understanding that the source of their conscious or unconscious racism is a result of their culture’s attempt to earn societal prestige through the control and dominance of cultures dissimilar to theirs. And, according to the Psychoanalytic approach, racism surfaces to serve as a defense mechanism of the ego and superego out of one’s fear of loneliness (Utsey, 2002). For Whites, as well as other groups, the attribution of cultural differences to minorities is a hidden expression of racial prejudice (Vala, 2009).

The majority as a minority. Often referred to as the majority, the Caucasian cultural group in many smaller communities represents the minority. In these instances, therapeutic approaches need to adjust due to the fact that many of these individuals have difficulty dealing with the sense that they are seeking racial acceptance from the majority culture, while they are experiencing discrimination. In many instances, one’s racial attitude is an attempt to manage an underlying anxiety associated with one’s intolerance of the dissimilar (Utsey, 2002). A therapist in this situation may find members of the White culture to be anxiety-ridden due to their inability to control the majority culture—which will in fact be a national minority group. Many of the areas where these inverted racial demographics exist are more likely to be impoverished. With a poverty level higher than the United States national average, some of the predominant issues for Whites in these areas are the difficulties stemming from their socioeconomic status. In these situations, it is likely that a great deal of Caucasian individuals are dealing with the denial of their Whiteness because of their shared socioeconomic status with African Americans and other national minority groups.

White privilege in these regions relies predominantly on one’s financial success; and because many Whites have not attained any substantial financial successes, it is more difficult to identify White privilege (Sue, 2010). Also, when Whites are the minority group, they are likely to be self-conscious of appearing racist; for example, it is highly unlikely that one would exhibit overtly racist behaviors if they are one of only seven White children in a class of forty-five students.

The Hispanic population. When functioning at a high level of cultural competence, a therapist treating an individual with a Hispanic cultural background understands the importance of being perceived as a knowledgeable and authoritative therapeutic professional. Likewise, these individuals should be aware that Hispanics are a heterogeneous culture, in that it comprises Cuban, Mexican, Puerto Rican, and several more ethnic groups, each with their own cultural values. Therapists must be knowledgeable of these various cultures, and that their primary similarity is that of sharing the same language; this makes effective intervention and treatment contingent upon understanding the dimensions of the specific client (Altarriba, 1994). The culturally competent clinician is also cognizant of the importance of addressing familial issues with the father of the family system, as Latinos are a highly patriarchal culture. In addition, the clinician should understand the significance of the structure of the entire extended family, as it is common for Hispanic households to include other family members, not solely the nuclear individuals. This family environment also plays a large role in the socialization of the children (Altarriba, 1998).

The role of the therapist also includes being open to alternative approaches to therapy, such as prayer and incorporating priests, as often the role of religion has a significant impact on the Latino family. It is also necessary for the culturally aware clinician to formulate the aspect of immigration into his or her therapeutic approach. Even in cases where the family or individual currently seeking counseling may not have immigrated into the U.S., there is the possibility that they have family members residing in their native country which impacts their current emotions and viewpoints. Furthermore, those who have immigrated have suffered through geographically separating themselves from many social or familial support systems which were previously established (Smart, 2001).

The therapist’s role, when working with Latinos, is also to aid with their assimilation with other cultures of the region, this includes the therapist and client being linguistically compatible. In many instances, Hispanic immigrants deal with their own language barrier within their household, as the parents tend to prefer speaking Spanish in the home, and the children (especially if born in the U.S.) may primarily speak English. The problem this presents to bilingual therapists is that the clinician tends to serve as merely the interpreter for both parties. Another risk associated with the bilingual therapist is in the aspect of dialect—if the therapist’s predominant language is English and they had to learn the Spanish as a second language, they must be fluent in a manner that displays the same authority and competency while speaking in the client’s language (Sciarra, 1991).

Although Hispanics represent the largest minority group in the United States, there are communities where the Hispanic population is less representative such as in Fairfield County, SC where they comprise less than 1.7% of the population. One objective for the therapist, when counseling a member of Hispanic culture, is to foster the client’s cultural awareness of their own cultural group as well increase their awareness of other minority and majority cultures. In essence, the therapeutic approach should include efforts to establish their acculturation. Hispanic individuals may need assistance from helping professionals simply because there is not a large preexisting population of Latinos where they reside, or in the surrounding areas. The primary discriminatory encounters they experience will originate from their skin color, illegal immigration, and reliance on physical labor due to the persistent language barriers (Smart, 2001). In areas where they are the overwhelming minority, the root of their cultural issues often resides in their constant search for acceptance and sense of belonging within the community, and among the other cultural groups.

Multiracial groups. Aside from the African American, Caucasian, and Hispanic cultures, one must also consider multiracial groups, as they hold 1.7% of the United States population. Individuals in this group tend to have their own issues, to include having several identities and not being one-dimensional (Allain, 2007). When requiring therapeutic assistance, they tend to bring a complex set of issues. The concept of culture will remain critical to therapists, as cultural roots are often maintained through parental socialization (Leong, 2010). When working with multicultural groups, therapists can generally model their approach by assessing the client’s racial and cultural identity development and forming a therapeutic alliance by gauging the client’s sensitivity to verbal and nonverbal cues. The therapist also formulates his methodology by assessing how the client identifies themselves collectively, individually, as well as how one’s family values affects the client (Delgado-Romero, 2001).

Often, in order for a therapist to develop a financially successful professional practice, it is essential to provide adequate therapy to both majority and minority cultures as well as cultures which differ from their own. To progress in doing this, it is necessary to conduct research to develop knowledge in a systematic way (Arzubiaga, 2008). In therapists’ attempts to obtain cultural competence, many run the risk of being superficial and counterproductive if they remain underdeveloped in the area of cultural sensitivity. The implementation of cultural competence and sensitivity offer a more rigorous and reflective methodology and therapists must keep that in mind. It is not necessary to become an expert on any particular culture, but rather to concentrate on being aware of one’s own perspective. As therapists, the utilization of critical thinking is vital to understanding how one’s own perspective can affect their ability to acknowledge and understand differing perspectives (Allain, 2007). Finally, be aware that culture is not simply race, and it is my belief that economic status in many instances holds an equal, if not greater, effect on ones manifestations which define their cultural identity.

References

Allain, L. (2007). An investigation of how a group of social workers respond to the cultural needs of black, minority ethnic looked after children. Practice, 19(2), 127-141.

Altarriba, J., Santiago-Rivera, A. L. (1994). Current perspectives on using linguistic and cultural factors in counseling the Hispanic client. Professional Psychology: Research and Practice, 25(4), 388-397.

In the most basic sense, therapy is a form of treatment for disorders. However, not every person that seeks therapy meets the full criteria for a clinical diagnosis, thus therapists are often engaging a client regarding presenting problems. These issues may or may not lead to diagnosis, but more often than not, are affecting the individual’s overall functionality. So, while you as a client may feel that you need therapy, understand that you may not be receiving treatment for a disorder. In many cases, at the request of the client, therapists seek to assist the client with restoring or increasing the client’s level of functionality (often recognized by the client as balance, happiness, meaning or fulfillment). This process typically includes a clinical assessment of the client’s level of functionality, and a determination on whether or not the client’s thoughts or actions meet the criteria for diagnosis.

In order to provide therapeutic assistance, therapists use their experience and expertise, which may be derived from a variety of tools, techniques, theories and models. Because of the vastness of the research, experiments and studies that have occurred over time, there are an abundance of valid (proven) approaches to therapy that may be chosen by a given practitioner. While there is no identified “best” approach to therapy, the client’s situation and the therapist’s competence play a large role in determining which model the therapeutic engagement will follow. If you are interested in seeking therapy, it may prove helpful to understand what specialties potential therapists claim, as well as what approach(es) to therapy they practice. Below is a comparative look at a few popular therapeutic models.

Reality Group Therapy versus Structural Family Therapy

While applying the Reality Group Therapy method, the therapist focuses on the individual’s control of their behaviors. The clinician aides the client in performing a self-evaluation in which they identify the quality of their behaviors, then determines what the contributors of their failures are. The therapist’s role is to guide the client through the process of developing a plan of action to eliminate these behaviors, and then hold them accountable throughout the execution of the devised plan by confronting them and identifying any possible deterrents or reasons for any incapability of completing the plan. The therapist and client work closely together to formulate the plan of action for the client to modify the behaviors causing their negative emotions in order to reach the desired outcome. Whereas, in Structural Family Therapy, the therapist emphasizes the dysfunctions of the family as opposed to strictly the individual’s control of the issues. Abiding by the Structural approach limits the therapist’s overall involvement as he is not used to establish intensive reparative for the family members, but to simply outline the framework, develop the foundation for reframing, and then encourage the family to continue a positive progression of growth. The Structural therapist’s role is to be an active agent in the process of restructuring the family, emphasize clear boundaries, facilitate the unearthing of hidden family conflicts and then outline the manner in which the family can modify them.

Person-Centered Therapy versus Strategic Family Therapy

The Person-Centered therapist is one who is congruent, removing all sense of authority and de-masking of professionalism. To be an effective Person-Centered therapist, it entails revealing personal information if it is an accelerant to the progression of therapy. Typically therapists have the general understanding of the limitations when involving self-disclosure; however, in Person-Centered therapy the clinician is transparent. Person-Centered therapy is client-guided as they explore their life experiences, and with the aid of the therapist, analyze their history and the result is the client resolving their own issues. In this approach, it is vital for the therapist to exude unconditional positive regard, providing no criticism, guidance for behavior, or discouraging them from any behaviors. In opposition, Strategic Family Theory requires the therapist to employ guidelines and directives, no matter how ambiguous. The Strategic therapist pays extreme attention to detail and accepts only the positive, whereas the Person-Centered therapist must accept all aspects of the client—positive as well as negative. Therapists abiding by the Strategic approach also develop a distinct outline for treatment involving defining the problem, investigating all solutions, defining clear change to achieve, and formulating strategy for change.

Rational Emotive Behavior Therapy contends that individual’s belief systems are responsible for emotional consequences. In theory, a client’s irrational beliefs could be effectively refuted by challenging them rationally and inevitably reducing the conflict. In a group setting, the therapist takes a lead role in attempting to change the minds of the clients. The therapist can accomplish this without fostering a “warm” relationship with the clients. In a group setting, there is potential for judgments to be made of group members by other members of the group, which may prove of benefit or detriment to the therapeutic experience. Rational Emotive Behavior Therapy holds that humans have the equal potential to be rational or irrational, and both preserving and destructive. Therapists must promote clients to confront their behaviors as well as accept their faults. Additionally, Rational Emotive Behavior therapists claim that it is possible to assist clients with changing their behaviors as a means to restructure their way of thinking. In this light, the therapist must continue to encourage self-discipline as well as self-direction. The primary similarity between Rational Emotive Behavior therapists and Psychodynamic therapists is that the principle focus of both is essentially for the client to reach full self-reliance, and operate at a high level of differentiation by exploring and developing their own autonomy. The Psychodynamic therapist accomplishes this not through confrontation, but through examining the client’s family of origin, constructing and dissecting a multigenerational diagram, and guiding the client to remove emotionality from their family system and begin approaching it from an objective approach in order to identify its highest level of functionality.

Because these comparisons are very general it may prove helpful to conduct further research regarding any approaches that are of interest. Additionally, understand that there are a multitude of other approaches to therapy as well and the best interpretation for you to have regarding any approach is the interpretation used by your therapist. Understand that even though some therapist’s practices are based on the same principals, each therapist will inevitably approach therapy in their own manner. This is to say that just because a certain therapy model was unsuccessful in the past with a specific therapist, you should not necessarily avoid seeking help from others utilizing a similar approach.

Despite a therapists’ ability to categorize issues, disorders and presenting problems, it is largely agreeable that all clients are unique. There are a plethora of reasons why a therapist may seek to gain familiarity with a specific therapeutic approach. Sometimes that reason is based simply on the therapists’ effort to best serve a local service population.

Herein are a few examples of how various therapeutic models may be used in particular instances. If you find yourself working with clients whose presenting problems are similar to the issues described in the examples, it may be beneficial to take some time to learn a little more about the model presented in that example.

Several approaches to therapy are very broad-based and may be used in a variety of contexts. It is possible for a therapist to become comfortable in such an approach, most likely because it works. Yet it is critical to understand that it is your responsibility as a helping professional to continually educate and professionally develop yourself.

The most basic benefit of researching other approaches is to build your knowledge-base.

However, through new understandings you are actually afforded opportunities to increase your level of experience. This process enables you to become a better therapist…efficiency via competence. While you don’t necessarily need to change your “style”, a new tool or technique may come in handy. Perhaps, take a look at some of the “classics” for inspiration…

A husband and wife are unable to agree on how to discipline their two small children. The wife grew up in a family where there was violence and child abuse. The husband’s father had a very demanding job and his mother was socially engaged.

Due to the distinct family of origin issues described, Bowen Family Therapy may be a viable approach to assist this family.

Using Bowen therapy, both parents should be assessed to discern if they have a healthy level of differentiation. Because they are having difficulty disciplining their children (a process in which the children are likely involved), they may run the risk of perpetuating the lineage of negative multigenerational transmissions. The conflict between the parents in regard to disciplining the children can result in triangulation as well as cutoffs.

In addition, because there are two children involved, therapy may include dealing with sibling position; in the event that this concept is budding while the children are “small” it would be prudent to address the issue in a timely manner.

Having the parents construct a genogram of their respective family of origin may prove helpful in a reasonably short amount of time. Through assisting these clients in dealing with unresolved issues, I believe that they would also find the disciplining of their children more agreeable and, in effect, they would be empowered to control their family’s multigenerational patterns.

An 8-year old girl has been wetting her bed for the last four weeks. Her parents began to argue frequently several months ago concerning the family budget. They are both frustrated by the bed wetting and desire an immediate solution.

Behavioral Family Therapy has its origin in parent’s modification of children’s actions. Not only does it appear at a glance that the parent’s discourse is responsible for the child’s bed wetting, but it seems that they have a problem with it as well. The parents need to know that they harness the ability to foster an environment for change, and, through training and empowering the parents, the therapist can allow the parents to take credit for working together to resolve the bed wetting issue.

By simply defining the problem behavior and then explaining the behavioral patterns to the parents, both the therapist and parents can monitor that behavior and as well monitor the child’s bed wetting habit as a means of marking progress.

It is foremost irrational that the parents believe that their child’s behavior can stop immediately; however, when concentrating on the dyadic parent relationship they will find that the family in its entirety will benefit.

A 12-year-old boy began displaying temper tantrums around the time his divorced mother announced she was going to remarry. She and her new husband are having a difficult time dealing with the situation.

One may lean upon the experiences of Minuchin (Structural Therapy) to assist the family in this scenario. By observing the patterns in this family, the therapist would hope to gain knowledge of the family’s structure. As well, it may be important to determine what may be different about the family structure once the mother remarried.

It is apparent that the divorce and second marriage were stressful times for the child. The child’s outcry could be in part due to the demolition of a coalition with his father. Though the family underwent a marital (or legal) restructuring, it may be necessary to restructure the “living” system in an effort to make the family stronger.

It may be plausible to address any incumbent boundaries caused by the marital shift. Due to the new “executive” system that is in place, it is necessary to evaluate the cohesion of that system and examine any residual effects. Additionally, this parental union may have to be alerted of the signs of triangulation as well as the methods for its avoidance.

The structural approach involves the technique of reframing, which can also be useful in assisting the child with coping with his “fits”. In short, there is a basic need for this family to redefine its boundaries to deal with the relevant stage of development. If appropriately applied, the Structural Approach may prove to be of assistance to this family.

A 34-year old female physician began getting anxious in elevators about 7 months ago. She became progressively more anxious in a variety of situations. Now she cannot cross bridges or go out to crowded places.

Cognitive-Behavioral Therapy, having roots in the social learning theory, would be a solid approach to this scenario. Cognitive restructuring may be a beneficial technique to accomplish modifying the client’s behaviors.

It is plausible that the client is dealing with issues regarding her beliefs and reasoning in a fashion that has affected her behavior. Through desensitization the client may be able to overcome the unnecessary anxiety that is associated with the situations described in the vignette.

By enhancing the client’s problem-solving and behavior-change skills she may be empowered to overcome her anxiety through a self-renown confidence. Additionally, a specific technique such as shaping could be employed, as it appears that the client has reached an extreme level of anxiety. It may require the client to take gradual steps towards such goals as crossing bridges and going into crowded places before she can achieve these feats.

A 43-year old male, recently unhappy with his career, sees himself as a failure and has begun to isolate himself because of a lack of confidence.

In dealing with this man’s career issue, one may employ the Strategic approach. In the vignette there is a clear problem that needs to be resolved or removed. It is beneficial to begin by defining the problem and then moving towards evaluating what the client has done to fix the issue.

By defining the necessary change and implementing a strategy for achieving that change, the client could be propelled to a more virtuous cycle. Additionally, the client could benefit from the reframing techniques practiced in Strategic Therapy.

By emphasizing positives and assisting the client through encouragement and direction, he may also begin to see his career in a different light. It seems the issue is rooted in his malcontent with his employment. In this instance I believe the lack of confidence may be a residual effect of his job situation. However, through combating his isolation through actions, he may be able to perpetuate his own confidence and gain a new awareness of his ability to acquire a job that may be more conducive to his happiness.

Another way the Strategic Approach may prove helpful is by utilizing the ordeals technique; in this instance the client may discard his isolated ways as he realizes that this behavior is not constructive.

A 24-year old male who is high functioning with no obvious diagnosis is confused about his goals in life.

Due to the over-functioning nature of the male depicted in the vignette, I believe that Experiential Therapy may be of most benefit, especially considering that there is no “obvious diagnosis”.

The Experiential approach is helpful because it relies on the personality of the therapist more so than that of the client. In this case, there is not much known about the client thus, the Experiential approach allows for the therapist to guide the therapeutic environment in an effort to learn more about the client. One manner in which the therapist can begin to assess the client is by evaluating the client’s level of individuality. An Experiential therapist can achieve this by fostering a warm climate in which the client feels respected and accepted.

As well, it is important for the client and therapist to work towards determining the nature of the client’s confusion (i.e. what about his life goals is confusing). The therapist has the ability to help the client see his confusion as meaningful. The client should be led to understand that it is productive to have goals and that his confusion pertaining them may only be a result of his personal growth.

By utilizing alternatives to reality, the therapist can allow the client to assess whether or not his goals are feasible, thus eliminating goals that are too vague or nested in improper judgments. The more excitement the therapist shows for the client’s progress, the greater stimulation the client is likely to experience, in turn providing the client opportunity for personal existential encounters.

While I may not be able to teach you more than you already know about these approaches, my effort is simply to remind you of the validity and importance thereof. If graduate school is the last time you encountered one of these models, consider this written for you.

If you are anything like me, you have spent a great deal of time in your life trying to figure out “why you are the way you are.” From your athletic ability to your thought processes, from your aptitude to your allergies. Many of us claim to remember where we came from, but fewer of us actually take the time to study the intricacies of the root and subsequent growth of the branch.

While events of significance such as being the victim of a crime, achieving a major accomplishment or the death of a loved one do shape who we are, it is often the small, monotonous and mundane which are not given much thought. While there are a myriad of avenues to approach the looking glass, in November of 2011 I took a look at my family history in search of answers, specifically outlining my family dynamics with the assistance of a genogram. To have an objective, I purposed this effort with discovering how my family of origin may impact my ability to assist clients in a clinical therapeutic setting.

I found that my family of origin provides me with both advantages and disadvantages in regard to my ability to provide therapeutic assistance to others. The complexities concerning my mother and father, both as a married couple and individually, provide such examples.

My mother has had a long history of mental illness and instability as well as multiple bouts with drug, alcohol and a variety of health issues. One may have a valid case depicting her as the quintessential candidate for therapeutic assistance. Though throughout my childhood I did not necessarily equate my disturbed relationship with her with the multitude of personal issues she had; however, it is relatively easy in hindsight to see how her issues played a role in the problems within our nuclear family.

My mother and father divorced when I was two years old and I did not have a relationship with my father from that point. My mother raised me until I was eight years old, at which time I became a tenant of a children’s home until the age of eighteen. Utilizing my own experiences with divorce and separation, I feel that I may be able to display certain empathy towards clients dealing with the same. Likewise, clients who have experienced an upbringing without a “standard” nuclear family may find it comfortable to discuss these matters with a person with a similar history. In this instance, having the experience of divorce and separation will give me the advantage of asking relevant questions, and implementing an array of techniques, concerning such.

Adversely, when working with clients of a “standard” nuclear family, I will likely rely on client input and professional research while having little life experience to guide me through the therapeutic process.

Also applicable to my family of origin is the concept of differentiation. When examining my role within my family system, it becomes clear that there was limited enmeshment, resulting in my centrifugal force propelling me towards differentiation. It is my aspiration to utilize my own processes for attaining differentiation to assist others who are dealing with fusion to gain flexible and adaptive traits as a means of conquering their dominant auto-emotional system.

I am the youngest of the three children born to my mother–one half-sister and one half-brother; as well I share my father with two half-brothers. No two of us grew up in the same household; however, starting in my young adulthood I was fortunate to begin establishing solid relationships with both of my maternal siblings; to date no significant relationships have been developed between myself and my paternal siblings.

Although I never experienced “sibling rivalry” with them, my relationships with them have exposed me to the concept of sibling position and how apparent it is that many of our personality traits can be attributed to our respective position. By growing up separately and then forging our sibling relationships as adults, I have the advantage of viewing my family more objectively; and this quality will prove to be quite beneficial as a clinician when attempting to have clients separate themselves from the emotionality surrounding any familial issues for which they are seeking treatment.

The hierarchical roles regarding the structure of my family provide another avenue for which I will have the ability to identify with families who need reframing. As a child, my sister was adopted and raised by my maternal grandparents, so in many ways she has fulfilled her role in the hierarchy not only as a sister, but also an aunt, and at times a parent.

Considering the nature of my relationships with the individuals in my family of origin, I did not necessarily notice any previously undiscovered factors based on the completion of the genogram. However, one notable aspect of Psychodynamic Therapy of which I had not previously considered is that of invisible loyalties as pertains to my relationship with my mother. I believe it would take some outside assistance to discern if this concept applies, but in my own assertion, it may explain why I have been able to reestablish my relationship with her after such an absence.

I understand that I felt resentment for her as a youth as a result of our separation; however, as an adult I have become more understanding, and in turn our relationship closed significant distance. Taking the time to use the genogram on myself has provoked me to redefine my family of origin in order to truly encompass my “family.” To accomplish this, I need to further this undertaking by way of including the relationships that occurred outside of my biological family of origin.

Based on my evaluations, I will move forward to construct a new “genogram” that includes other relationships that I believe to have been “like” family. In this plight, I hope to attain a greater understanding of whom my family really consists.

In summation, the structure of my family, my relationships with each member of the system, and how I grew up, are the primary reasons I possess such a significant interest in Marriage and Family Therapy. I acknowledge that it will be my responsibility to conduct as much research as possible regarding treatment for the entire spectrum of “family types.” However, I already hold the position that every patient will be different, and no two families will ever be identical.

My family and life experiences will allow me to identify with non-traditional families in a unique manner of which I hope to be both sensitive and therapeutic. Also, by exposing descriptions of my family life with clients, they will be comforted by understanding my competency in treating them, it will also allow for a greater level of professional trust, which will significantly progress treatment.

Finally, as I continue my efforts to become credentialed to provide Marriage and Family Therapy, I believe that taking the time to explore and become familiarized with the tools available to the profession is critical to establishing who I will be as a professional. During my graduate education, Family Systems was one area that I enjoyed studying, thus the efforts such as the one mentioned above, I believe will help me transition my interests into practice, even before I am able to sit face-to-face with a client.

I have utilized a similar approach to familiarizing myself with items such as the Myers-Briggs Type Indicator and the Taylor-Johnson Temperament Analysis.

Continue to follow this blog to learn about my experiences with these personality assessments and other therapeutic tools.